2017-02-06T06:59:46-06:00 2016-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2015-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI VICE PRESIDENT/CFO 8605279126 2017-02-02 1 ELIZABETH SOLECKI P00235171 8605614000 2017-01-30 2015 2021-01-29 14:40:06Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 40998078 0 X WWW.CHURCHHOMES.ORG X 1957 CT TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS. 13 12 497 240 0 0 402859 2430717 39433947 37874870 1542072 74310 442748 499202 41821626 40879099 10150 11887 0 0 22590556 22516269 0 0 99776 17661712 17194522 40262418 39722678 1559208 1156421 55079347 56370256 19292559 18285417 35786788 38084839 X TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS BY PROMOTING AND IMPLEMENTING SYSTEMS THAT MAINTAIN AND SUPPORT EVERY INDIVIDUAL'S OPTIMAL INDEPENDENCE AND LIFE WISHES IN A SAFE, DIGNIFIED ATMOSPHERE CONDUCIVE TO QUALITY RETIREMENT, BY ASSURING KNOWLEDGEABLE AND CONSISTENT LEADERSHIP IN RETIREMENT LIVING, LONG-TERM CARE, HOME CARE AND SUPPORT SERVICES AND BY DEVELOPING INNOVATIVE PROGRAMS AND SERVICES WHICH RESPOND TO THE CHANGING NEEDS OF ITS RESIDENTS AND CLIENTS AND THE SOCIETY IT SERVES. 0 0 36220067 11887 38368672 CHURCH HOMES, INC. CONGREGATIONAL IS A NOT-FOR-PROFIT CORPORATION, WHICH OWNS AND OPERATES RETIREMENT AND HEALTH CARE FACILITIES IN HARTFORD, CT (AVERY HEIGHTS) AND SALISBURY, CT (NOBLE HORIZONS). AVERY HEIGHTS CONSISTS OF 130 SKILLED NURSING BEDS, 69 INTERMEDIATE CARE BEDS, 58 INDEPENDENT LIVING COTTAGES, AND 137 INDEPENDENT LIVING APARTMENTS. IN ADDITION, AVERY HEIGHTS OPERATES A HOME HEALTH AGENCY. NOBLE HORIZONS CONSISTS OF 61 SKILLED NURSING BEDS, 30 INTERMEDIATE CARE BEDS, 50 INDEPENDENT LIVING COTTAGES, AND 19 ACCOMMODATIONS IN A HOME FOR THE AGED. 36220067 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 133 0 1 497 1 0 0 0 0 0 1 1 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 CT X RAYMOND A GASPERINI 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 PATRICK GILLAND PRESIDENT/CEO 40.00 5.00 X X 280917 0 52024 PATRICK Y YUNG DIRECTOR 1.00 0.00 X 0 0 0 THOMAS P KELLEY DIRECTOR 1.00 0.00 X 0 0 0 JOSEPH C BLACK JR DIRECTOR 1.00 0.00 X 0 0 0 DAVID E CANUEL CHAIRMAN 1.00 0.00 X X 0 0 0 ELIZABETH S GAGNE DIRECTOR 1.00 0.00 X 0 0 0 HENRY B MCNULTY VICE CHAIRMAN 1.00 0.00 X X 0 0 0 DAVID E POLK DIRECTOR 1.00 0.00 X 0 0 0 GERARD J BALDWIN DIRECTOR 1.00 0.00 X 0 0 0 PETER B MATTHEWS DIRECTOR 1.00 0.00 X 0 0 0 MERCEDESE E LARGE DIRECTOR 1.00 0.00 X 0 0 0 PETER L HOLLAND DIRECTOR 1.00 0.00 X 0 0 0 PATRICK S GILLIGAN DIRECTOR 1.00 0.00 X 0 0 0 RAYMOND GASPERINI VICE PRESIDENT/CFO 40.00 0.00 X 183008 0 34210 EILEEN MULLIGAN VICE PRESIDENT 40.00 0.00 X 173147 0 25711 MIRIAM PARKER VICE PRESIDENT 40.00 0.00 X 189285 0 37497 MARJORIE K TESSMAN SECRETARY 30.00 0.00 X 45426 0 5923 WILLIAM THOMPSON VICE PRESIDENT 40.00 0.00 X 0 0 0 RUTH DONAHUE CONTROLLER 40.00 0.00 X 103117 1500 30361 BONITA GANIM DIRECTOR OF NURSING SERVICES 40.00 0.00 X 110537 0 17971 ANNA LUKAS NURSE MANAGER 40.00 0.00 X 139256 0 23790 MICHELLE PASCETTA DIR BUDGETING AND REIMBURSEMENT 40.00 0.00 X 113314 0 24409 JAMMIE SCANLON-CLEARY LPN 40.00 0.00 X 101879 0 29472 1439886 1500 281368 10 0 1 0 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY/DIETARY SERVICES 2714832 ALLIANCE REHAB OF CT 1520 KENSINGTON RD STE 110 OAK BROOKE IL 60523 REHAB THERAPY 1566427 D SAYADOFF & CO PO BOX 996 BLOOMFIELD CT 06002 PAINTER 295125 H&H LINEN SERVICES 60 BELAMOSE AVE UNIT A10 ROCKY HILL CT 06067 LINEN SERVICE 200916 QUALITY FLOORING 21 BRENNAN ROAD AMSTON CT 06231 FLOORING 188674 12 113009 2317708 2430717 RESIDENT SERVICES 623000 37765074 37765074 OTHER SERVICES 623000 109796 109796 37874870 143712 143712 5400 0 5400 5400 5400 1083 70485 0 -70485 1083 -69402 -69402 48494 113009 48494 0 OTHER INCOME 900099 490178 490178 FEES INCOME 900099 3624 3624 493802 40879099 38368672 0 79710 X 11887 11887 995071 995071 15890458 13810174 2069839 10445 1191270 1043433 147003 834 3163592 2754903 406384 2305 1275878 1117542 157443 893 3047 3047 155873 155873 80075 80075 6159228 6115662 28971 14595 132695 128538 3152 1005 254055 143221 100621 10213 168419 77585 78567 12267 2491147 2461370 29777 10586 4595 5991 3547 904 1364 1279 83 83 2599392 2599392 278564 278564 PROVIDER TAX 1647800 1647800 SUPPLIES 688145 668042 20103 FOOD 676588 676588 PRESCRIPTIONS & DRUGS 476072 476072 1369206 1208641 114625 45940 39722678 36220067 3402835 99776 2221989 2131806 394413 399070 2601715 2633104 199997 207297 567292 352653 83042850 56300484 27861038 26742366 20555355 22826950 637830 1036816 39718 40194 55079347 56370256 3263787 3021134 15622301 14933006 406471 331277 19292559 18285417 X 26823071 26664397 6311452 8768177 2652265 2652265 35786788 38084839 55079347 56370256 1156421 1141630 0 X 0 1 X 1 0 X 598288 371877 593147 402859 2430717 4396888 40215164 40366544 40130440 39859295 38368672 198940115 40813452 40738421 40723587 40262154 40799389 203337003 0 0 0 203337003 289151 158361 487434 189677 143712 1268335 289151 158361 487434 189677 143712 1268335 17525 18000 18000 17400 5400 76325 41120128 40914782 41229021 40469231 40948501 204681663 0.99340 0.99270 0.00620 0.00660 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9692954 87798 960411 371513 10369650 10152116 131662 -262110 328714 9692954 9297884 354207 680438 180413 10152116 8485427 83398 904516 175457 9297884 6929974 401654 1344982 189371 1812 8485427 0.53000 0.25000 0.22000 0 0 2744217 2744217 50647730 33607079 17040651 25669767 19851668 5818099 3981136 2841737 1139399 26742366 ANNUITIES PAYABLE 66239 RESIDENT FUNDS AND DEPOSITS 203198 DUE TO THIRD PARTY REIMBURSEMENT AG 58347 MISCELLANEOUS 3493 331277 41806110 1141630 -214619 927011 40879099 0 40879099 39508059 0 39508059 214619 214619 39722678 PART V, LINE 4: INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT -2,886. BAD DEBTS -61,283. LOSS ON REFINANCING -150,450. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT RESIDENT SUPPORT 2,886. BAD DEBTS 61,283. LOSS ON REFINANCING 150,450. GOLF OUTING 74895 53462 21433 21433 FESTIVAL OF TREES 18883 13410 5473 5473 1 67725 46137 21588 21588 161503 113009 48494 48494 48494 0 1 SCHOLARSHIPS 5 11887 PART I, LINE 2: SCHOLARSHIP ASSISTANCE IS OFFERED TO EMPLOYEES OR THEIR CHILDREN WHO WISH TO PURSUE PROFESSIONAL AND VOCATIONAL COURSES OF STUDY THAT ARE RELATED TO THE EMPLOYEE'S POTENTIAL FOR PROMOTION OR MINIMUM JOB REQUIREMENTS. ALL COURSES MUST BE OFFERED THROUGH AN ACCREDITED INSTITUTION OF HIGHER LEARNING OR BE APPROVED FOR CONTINUING EDUCATION UNITS. TO QUALIFY, THE EMPLOYEE MUST BE EMPLOYED 32 HOURS OR MORE AND HAVE COMPLETED ONE YEAR OF CONTINUOUS EMPLOYMENT. THE EMPLOYEE MUST HAVE A GOOD WORK ATTENDANCE RECORD. THE EMPLOYEE OR THEIR CHILD MUST MEET THE REQUIREMENTS OF THE INSTITUTION OR AGENCY OFFERING THE COURSE. THE SCHOLARSHIP ASSISTANCE IS AVAILABLE IF THE APPLICANT IS NOT ELIGIBLE FOR ASSISTANCE FROM OTHER SOURCES OF REIMBURSEMENT. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 PATRICK GILLAND PRESIDENT/CEO 255917 0 25000 0 0 0 31716 0 20308 0 332941 0 0 0 RAYMOND GASPERINI VICE PRESIDENT/CFO 180008 0 3000 0 0 0 21095 0 13115 0 217218 0 0 0 EILEEN MULLIGAN VICE PRESIDENT 170147 0 3000 0 0 0 19367 0 6344 0 198858 0 0 0 MIRIAM PARKER VICE PRESIDENT 186285 0 3000 0 0 0 22234 0 15263 0 226782 0 0 0 ANNA LUKAS NURSE MANAGER 139256 0 0 0 0 0 10483 0 13307 0 163046 0 0 0 PART I, LINE 7 BONUSES ARE AWARDED BASED ON THE ACHIEVEMENT OF SPECIFIC PERFORMANCE GOALS. A STATE OF CONNECTICT HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 060806186 2015-11-18 15282000 REFUND PRIOR ISSUE 0 0 0 A 15282000 134222 15147778 1 0 1 1 A 0 0 0 0 0.01680 0.00000 0.01680 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 PART II, LINE 11, OTHER SPENT PROCEEDS: OTHER SPENT PROCEEDS OF $15,147,778 WERE USED TO REFUND A PRIOR ISSUE. CROWN LINEN SUBSTANTIAL CONTRIBUTOR 128754 COMPENSATION FOR SERVICES 0 MCKESSON SUBSTANTIAL CONTRIBUTOR 206009 COMPENSATION FOR SERVICES 0 PEOPLE'S SUBSTANTIAL CONTRIBUTOR 947783 COMPENSATION FOR INSURANCE 0 QUALITY FLOOR COVERINGS SUBSTANTIAL CONTRIBUTOR 157515 COMPENSATION FOR SERVICES 0 ALLIANCE REHAB SUBSTANTIAL CONTRIBUTOR 1474489 COMPENSATION FOR SERVICES 0 HEALTHCARE SERVICES GROUP INC SUBSTANTIAL CONTRIBUTOR 2575183 COMPENSATION FOR SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED WITH THE BOARD OF DIRECTORS AT REGULARLY SCHEDULED BOARD OF DIRECTORS MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE PRESIDENT OF CHURCH HOMES, INC. REVIEWS THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE WITH THE COMMITTEE ON DIRECTORS. WHERE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE COMMITTEE ON DIRECTORS IS AUTHORIZED TO TAKE APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 CHURCH HOMES, INC. PERSONNEL COMMITTEE REVIEWS AND APPROVES OFFICER COMPENSATION ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL THERAPY: PROGRAM SERVICE EXPENSES 1,577,746. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,577,746. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 1,755,577. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,755,577. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 810,992. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 810,992. TEMPORARY NURSING: PROGRAM SERVICE EXPENSES 362,558. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 362,558. SECURITY: PROGRAM SERVICE EXPENSES 143,601. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 143,601. LAUNDRY: PROGRAM SERVICE EXPENSES 493,624. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 493,624. MAINTENANCE & REPAIRS: PROGRAM SERVICE EXPENSES 553,980. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 553,980. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 417,584. MANAGEMENT AND GENERAL EXPENSES 28,971. FUNDRAISING EXPENSES 14,595. TOTAL EXPENSES 461,150. CONNECTICUT ALLIANCE FOR LONG TERM CARE 217 AVERY HEIGHTS HARTFORD CT 06106 061465316 ADMINISTER PROVIDER BASED NETWORK TO PROVIDE COST-EFFECTIVE HEALTH CARE CT 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0